Review Flashcards
(497 cards)
1
Q
Which analytes are affected by diurnal variation and are increased in the AM?
A
ACTH, cortisol, iron
2
Q
Which analytes are affected by diurnal variation and are increased in the PM?
A
growth hormone, PTH, TSH
3
Q
Fasting samples are required for which chemistry tests?
A
fasting glucose, triglycerides, and lipid panel
4
Q
Alcohol will have what affect on glucose?
A
alcohol will decrease glucose levels
5
Q
Alcohol will have what affect on GGT and triglycerides?
A
alcohol will increase these analytes
6
Q
Stress can increase which three anallytes?
A
ACTH, cortisol, and catecholamines
7
Q
Which analytes require being chilled after sample collection?
A
ammonia, lactic acid, and blood gas
8
Q
Which analytes will be decreased when exposed to light?
A
bilirubin and carotene
9
Q
When pumping the fist during sample collection, what analytes may increase, which then affects the pH by (increasing/lowering) it?
A
Increase in K, lactic acid, Ca, Phosphorous
Lowered pH
10
Q
Which analytes may increase in a sample that was collected with prolonged use of a tourniquet?
A
K, total protein, lactic acid
11
Q
If a sample was delayed in separating serum/plasma, which analytes will be increased?
A
ammonia, lactic acid, K, Mg, LD
12
Q
If a sample was delayed in separating serum/plasma, which analyte will be decreased?
A
glucose (unless collected in fluoride)
13
Q
Total protein, LD and Ca are higher in serum or plasma?
A
plasma
14
Q
K, phosphate, glucose, CK, HCO3, ALP, ALB, AST, and trigs are higher in serum or plasma?
A
serum
15
Q
Glucose is higher in plasma or whole blood?
A
plasma
16
Q
Glucose (postprandial) and K are higher in capillary blood or venous blood?
A
capillary
17
Q
Ca and total protein are higher in capillary blood or venous blood?
A
venous blood
18
Q
K, phosphate, and Mg are higher in plasma or RBCs?
A
RBCs
19
Q
Na and Cl are higher in plasma or RBCs?
A
plasma
20
Q
A basic metabolic panel tests for which 8 analytes?
A
Na, K, Cl, CO2, GLU, Crea, BUN, and Ca
21
Q
A comprehensive metabolic panel tests for which 13 analytes?
A
Na, K, Cl, CO2, GLU, Crea, BUN, ALB, Total Protein, ALP, AST, Bili, and Ca
22
Q
An electrolyte panel tests for which analytes?
A
Na, K, Cl, CO2
23
Q
A hepatic function panel tests for which 7 analytes?
A
ALB, ALT, AST, ALP, Bili (total), Bili (conjugated), total protein
24
Q
A lipid panel tests for which analytes?
A
total cholesterol, HDL, LDL, and Trigs
25
A renal function panel tests for which 9 analytes?
Na, K, CO2, GLU, Crea, BUN, Ca, ALB, and phosphate
26
What substance is a major source of cellular energy and has decreased levels at room temp?
glucose
27
What additive is used to prevent glycolysis?
sodium fluoride
28
What are the most common methods for measuring glucose?
glucose oxidase and hexokinase
29
Diabetes mellitus, other endocrine disorders, acute stress, and pancreatitis may result due to hyperglycemia or hypoglycemia?
hyperglycemia
30
Possible causes of hypoglycemia:
insulinoma, insulin-induced hypoglycemia, hypopituitarism
31
Which methods are most commonly used to test total cholesterol?
enzymatic methods
32
Since total cholesterol is of little value in predicting CAD, it is typically tested along with which other analytes?
HDL and LDL
33
Which analyte is inversely related to CAD?
HDL
34
Which two lipids are risk factors for CAD?
LDL and Trigs
35
Which cholesterol is good?
HDL
36
What is the Friedewald formula and what does it calculate?
LDL = (total cholesterol) - (HDL) - (Trigs/5)
**Trigs cannot exceed 400 mg/dL**
Calculates LDL
37
How are LDL levels determined?
Calculated via the Firedewald equation or measured via direct homogenous assays
38
What is the main form of lipid storage?
Triglycerides
39
What methods are used to measure Trigs?
enzymatic methods using lipase
40
What type of specimen is required for testing trigs?
fasting specimen
41
How does dehydration, chronic inflammation, and multiple myeloma affect total protein levels?
increases TP levels
42
Nephrotic syndrome, malabsorption, overhydration, hepatic insufficiency, malnutrition, and agammaglobulinemia affect TP how?
decreases TP
43
Very low levels of TP are associated with
peripheral edema
44
Total protein is measured via which method?
Biuret method
45
What is the Biuret method?
Used to measure total protein by using an alkaline copper reagent that reacts with peptide bonds
46
Which analyte is the largest fraction of plasma proteins?
albumin
47
Albumin is increased or decreased with dehydration?
increased
48
Albumin regulates...
osmotic pressure
49
Malnutrition, liver disease, nephrotic syndrome, and chronic inflammation will increase or decrease albumin?
decrease
50
How is albumin measured?
Via dye-binding (BCG or BCP)
51
Which analyte is predictive of diabetic nephropathy?
microalbumin
52
What specimen is used to test microalbumin?
24 hour urine
53
How can microalbuminuria be determined on a random sample?
using the ALB:Crea ratio
30-300 mg albumin/g creatinine
54
Which hormone decreases glucose levels?
insulin
55
What is responsible for entry of glucose into cells?
insulin
56
In the regulation of glucose, insulin increases...
glycogenesis
57
Which 5 hormones increase glucose levels?
glucagon, cortisol, epinephrine, growth hormone, and thyroxine
58
In the regulation of glucose, Glucagon stimulates...
glycogenolysis and gluconeogenesis
59
In the regulation of glucose, Glucagon inhibits...
glycolysis
60
Which hormones are insulin antagonists?
cortisol and growth hormone
61
In the regulation of glucose, cortisol increases...
gluconeogenesis
62
In the regulation of glucose, epinephrine promotes...
glycogenolysis and gluconeogenesis
63
In the regulation of glucose, thyroxine stimulates...
glycogenolysis
64
How does thyroxine act in the regulation of glucose?
increases glucose absorption for GI tract
65
What condition is prone to ketoacidosis and diabetic complications?
Type 1 Diabetes
66
Type 1 diabetes is an autoimmune disorder with the destruction of ...... resulting in what deficiency?
destruction of beta cells resulting in absolute insulin deficiency
67
Which type of diabetes mellitus has a genetic predisposition?
Type 1
68
Insulin resistance in peripheral tissues can cause...
Type 2 diabetes
69
What are 2 possible causes for Type 2 diabetes?
insulin resistance in peripheral tissues and insulin secretory defect of beta cells
70
Which type of diabetes is associated with obesity?
Type 2
71
What cells secrete insulin?
beta cells
72
Which type of Diabetes typically has an onset later in life?
Type 2
73
Which type of diabetes is not dependent on exogenous insulin?
Type 2
74
What is the cause of gestational diabetes?
placental lactogen inhibits action of insulin
75
What test is performed only on a patient with symptoms of hyperglycemia and the sample can be collected at any time of the day without regard to time since their last meal?
Random plasma gluose
76
How long must a patient fast for a fasting plasma glucose?
at least 8 hours
77
What result for a random plasma glucose is indicative of diabetes mellitus?
>200 mg/dL
78
What result for a fasting plasma glucose is indicative of diabetes mellitus?
>126 mg/dL on 2 occasions
79
Which diabetes test is only used to test for gestational diabetes?
oral glucose tolerance test (OGTT)
80
When is an oral glucose tolerance test performed?
24-28 weeks gestation
81
What result for a Hgb A1C is indicative of diabetes?
>6.5%
82
Which test gices an estimate of glucose control over the previous 2-3 months?
Hgb A1C
83
TRUE OR FALSE: Hgb A1C test can be used to diagnose diabetes in patients with hemoglobinopathies or abnormal RBC turnover.
FALSE
84
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
Blood glucose
increased
85
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
urine glucose
increased
86
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
urine specific gravity
increased
87
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
glycohemoglobin
increased
88
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
ketones
increased
89
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
anion gap
increased
90
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
BUN
increased
91
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
osmoality
increased
92
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
cholesterol
increased
93
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
triglycerides
increased
94
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
bicarbonate
decreased
95
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
blood pH
decreased
96
What is defined as: A group of risk factors that seem to promote development of atherosclerotic cardiovascular disease and Type 2 Diabetes Mellitus?
Metabolic Syndrome
97
What are the 5 risk factors of metabolic syndrome?
decreased HCL, increased LDL, Trigs, Blood pressure, and blood glucose
98
Which aminoacidopathy is caused by a deficiency of an enzyme that converts phenylalanine to tyrosine leading to phenylpyruvic acid in the blood and urine?
phenylketonuria
99
Due to the build up of phenylpyruvic acid, patients with PKU tend to have urine with what odor?
mousy odor
100
Which aminoacidopathy can lead to mental retardation due to phenylalanine build-up?
phenylketonuria
101
The Guthrie bacterial inhibition assay can be performed to diagnose...
PKU
102
All newborns are screened for which aminoacidopathy?
Phenylketonuria
103
Which aminoacidopathy is caused by a disorder of tyrosine catabolism, resulting in tyrosine and its metabolites excreted in urine?
Tyrosinemia
104
What is the effects of tyrosinemia?
Liver and kidney disease, death
105
Which aminoacidopathy is caused by a deficiency or an enzyme needed in tyrosine and phenylalanine metabolism, resulting in the buildup of homogentisic acid?
Alkaptonuria
106
A patient with alkaptonuria will have diapers that stain black due to the build up of...
homogentisic acid in urine
107
A patient with which aminoacidopathy will, later in life, have darkening of tissues along with hip and back pain?
alkaptonuria
108
Maple syrup urine disease is caused by the build up of which amino acids?
leucine, isoleucine, and valine
109
A burnt-sugar odor to urine, breath, and skin is associated with which aminoacidopathy?
Maple syrup urine disease
110
Failure to thrive, mental retardation, acidosis, seizures, coma, and death are effects of which aminoacidopathy?
maple syrup urine disease
111
Which aminoacidopathy is caused by the deficiency of an enzyme needed for methionine metabolism?
homocystinuria
112
What builds up in the plasma and urine in homocystinuria?
methionine and homocystine
113
Osteoporosis, dislocated optic lenses, mental retardation, and thrombolytic events are effects of which aminoacidopathy?
homocystinuria
114
Which aminoacidopathy is caused by defective renal reabsorption of cysteine?
cystinuria
115
A positive (red-purple color) result on a urine cyanide nitroprusside test is diagnostic for...
cystinuria
116
Recurring kidney stones is an effect of which aminoacidopathy?
cystinuria
117
Proteins are (negatively or positively) charged and move toward the (anode or cathode).
negatively charged and move toward the anode
118
What is the order of migration from fastest to slowest in protein electrophoresis?
ALB, alpha-1, alpha-2, beta, gamma
119
Bence Jones proteins migrate to which region in protein electrophoresis?
gamma globulin region
120
Which specimen will have a prealbumin band in protein electrophoresis?
CSF
121
An increase in alpha-1 and alpha-2 regions is a common serum protein electrophoresis pattern for...
acute inflammation
122
An increase in alpha-1, alpha-2, and gamma globulin regions is a common serum protein electrophoresis pattern for...
chronic infection
123
Beta-gamma bridging is a common serum protein electrophoresis pattern for...
Cirrhosis
124
A sharp increase in one immunoglobulin (M spike) and a decrease in all other fractions is a common serum protein electrophoresis pattern for...
monoclonal gammopathy
125
A diffuse increase in gamma globulins is a common serum protein electrophoresis pattern for...
polyclonal gammopathy
126
A decrease in the gamma globulin region is a common serum protein electrophoresis pattern for...
hypogammaglobulinemia
127
A decrease in albumin and an increase in alpha-2 is a common serum protein electrophoresis pattern for...
Nephrotic syndrome
128
A decrease in the alpha-1 region is a common serum protein electrophoresis pattern for...
Alph-1-antitrypsin deficiency
129
An increase in the beta region or an unusual band between alpha-2 and beta regions is a common serum protein electrophoresis pattern for...
hemolyzed sample
130
An extra band between the beta and gamma regions is a common serum protein electrophoresis pattern for...
plasma (fibrinogen)
131
What analyte is synthesized by the liver from ammonia?
BUN
132
An increase in BUN is clinically significant for
kidney disease
133
Which analyte is used as a urease reagent?
BUN
134
```
Which of the following tubes cannot be used for BUN?
sodium fluoride
EDTA
citrate
lithium heparin
ammonium heparin
```
All except lithium heparin cannot be used for BUN
135
An increase in creatinine is clinically significant for...
kidney disease
136
What analyte is a waste product from dehydration of creatine?
creatinine
137
The Jaffe reaction uses which reagent to test for which analyte?
The Jaffe reaction uses picrate (alkaline) to test for creatinine.
138
What is the normal BUN:Crea ratio?
12-20
139
Increased uric acid can be clinically significant for...
gout, renal failure, ketoacidosis, lactate excess, high nucleoprotein diet, leukemia, lymphoma, polycythemia
140
A decrease in uric acid can be clinically significant for...
administration of ACTH, renal tubular defects
141
Increased levels of uric acid increase the risk for...
renal calculi and joint trophi
142
EDTA and fluoride interfere with the uricase method, which tests for...
uric acid
143
Why must urine pH be adjusted to 7.5-8 when determining uric acid levels?
to prevent precipitation
144
An increase in ammonia can be clinically significant for...
liver disease, hepatic coma, renal failure, Reye's Syndrome
145
Which analyte is produced in the GI tract and high levels are neurotoxic?
ammonia
146
Ammonia should be collected in which tubes?
EDTA or heparin
147
Why will serum have increased levels of ammonia?
NH3 is generated during the clotting process
148
Causes of hypernatremia:
increased intake, IV administration, hyperaldosteronism, excessive sweating, burns, diabetes insipidus
149
Hypernatremia can cause:
tremors, irritability, confusion, coma
150
Causes of hyponatremia:
renal or extrarenal loss (vomiting, diarrhea, sweating, burns), increased extracellular fluid volume
151
Hyponatremia causes:
weakness, nausea, altered mental status
152
What is the major extracellular cation?
Sodium
153
Which analyte contributes to almost half of plasma osmolality?
sodium
154
Which analyte maintains normal distribution of water and osmotic pressure?
sodium
155
Sodium levels are regulated by...
aldosterone
156
What is the most common method for testing sodium?
ISE (ion-selective electrode)
157
Causes of hyperkalemia:
increased intake, decreased excretion, crush injuries, metabolic acidosis
158
Hyperkalemia can cause:
muscle weakness, confusion, cardiac arrhythmia, cardiac arrest
159
Causes of hypokalemia:
increased GI or urinary loss, diuretic use, metabolic alkalosis
160
Hypokalemia can cause:
muscle weakness, paralysis, breathing problems, cardiac arrhythmia, death
161
What is the major intracellular cation?
Potassium
162
Why are serum potassium levels higher than in plasma?
platelets release K during the clotting process
163
Squeezing the capillary site, prolonged tourniquet, pumping fist during venipuncture, IV fluid contamination, hemolysis, prolonged RBC contact, leukocytosis, and thrombocytosis can all increase which electrolyte values?
Potassium
164
What are the major electrolytes?
Na, K, Cl, and CO2 (total)
165
Causes of hyperchloremia:
Increased intake, IV administration, hyperaldosteronism, excessive sweating, burns, diabetes insipidus, excessive loss of HCO3
166
Sodium follows...
WATER
167
What is the major extracellular anion?
Chloride
168
Which electrolyte helps maintain osmolality, blood volume, and electric neutrality?
Chloride
169
Which electrolyte passively follows sodium?
Chloride
170
The sweat Cl test is diagnostic for...
cystic fibrosis
171
90% of total CO2 is in what form?
Bicarbonate (HCO3)
172
Increased total CO2 is clinically significant for...
metaboilic alkalosis and compensated repiratory acidosis
173
Total CO2 is composed of...
Mainly bicarb, but also carbonic acid and dissolved CO2
174
HCO3 is important in maintaining...
acid-base balance
175
Decreased total CO2 is clinically significant for...
metabolic acidosis and compensated respiratory alkalosis
176
If an electrolyte sample is uncapped, which electrolyte is affected and how?
Total CO2 will decrease
177
Causes of increased magnesium:
renal failure, increased intake (antacids), dehydration, bone cancer, endocrine disorders
178
Increased magnesium can cause:
cardiac abnormalities, paralysis, respiratory arrest, coma
179
Causes of decreased magnesium:
severe illness, GI disorders, endocrine disorders, renal loss
180
Decreased magnesium can lead to...
cardiac arrhythmias, tremors, tetany, paralysis, psychosis, coma
181
A decrease in which electrolyte is rare in non-hospitalized patients?
Magnesium
182
Oxalate binds which electrolyte?
Mg
183
Causes of increased calcium:
primary hyperparathyroidism, cancer, multiple myeloma
184
Increased calcium can cause:
weakness, coma, GI symptoms, renal calculi
185
Causes of decreased calcium:
hypoparathyroidism, malabsorption, vitamin D deficiency, renal tubular acidosis
186
Decreased calcium can cause:
tetany (muscle spasms), seizures, cardiac arrhythmias
187
What is the most abundant mineral in the body?
calcium (99% in the bones)
188
Which electrolyte is controlled by the parathyroid, vitamin D, and calcitonin?
calcium
189
Why is heparin the only anticoagulant used to calcium samples?
all other anticoagulants bind calcium
190
What is the biologically active form of calcium?
ionized (free) Ca
191
TRUE OR FALSE: Calcium is not affected by pH or Temp
FALSE
192
Causes of increased phosphorous:
renal disease, hypoparathyroidism
193
Causes of decreased phosphorous:
hyperparathyroidism, Vitamin D deficiency, renal tubular acidosis
194
What is the major intracellular anion?
phosphorous
195
Phosphorous is a component of...
nucleic acids and many enzymes
196
Phosphorous is a major reservoir for...
energy (ATP)
197
Phosphorous is correlated with which other electrolyte?
Calcium
198
The presence of lactate is a sign of...
decreased oxygen to tissues
199
Which electrolyte is a byproduct of anaerobic metabolism?
lactate
200
lactate samples should be collected in which tube?
heparin
201
What are collection requirements for lactate?
Use a heparin tube and put on ice immediately or use fluoride to inhibit glycolysis
202
What analyte is necessary for hemoglobin synthesis?
iron
203
Iron is transported by...
transferrin
204
What specimen is preferred for iron due to diurnal variation?
morning specimen
205
Clinical significances of increased iron:
iron overdose, hemochromatosis, sideroblastic anemia, hemolytic anemia, liver disease
206
Clinical significances of decreased iron:
iron deficiency anemia
207
How is the total iron binding capacity determined?
Iron is added to saturate the transferrin in a sample, the excess is removed, and iron content is determined
208
TIBC is (proportional/inversely) related to iron content.
inversely
209
What is the clinical significance of an increased TIBC?
iron deficiency anemia
210
What is the clinical significance of a decreased TIBC?
iron overdose, hemochromatosis
211
100 X (serum iron/TIBC) = ?
% saturation (or transferrin saturation)
212
What is the protein that transports iron?
apotranferrin
213
The apotransferrin - iron complex is considered...
transferrin
214
Increased transferrin is clinically significant for...
iron deficiency anemia
215
Decreased transferrin is clinically significant for...
iron overdose, hemochromatosis, chronic infections, malignancies
216
What is the storage form of iron?
ferritin
217
What analyte is a rough estimate of body iron content?
ferritin
218
Increased ferritin is clinically significant for...
iron overload, hemochromatosis, chronic infections, malignancies
219
Name 6 factors that influence enzymatic reactions.
substrate concentration, enzyme concentration, temperature, pH, cofactors, and inhibitors
220
Acid phosphatase (ACP) is found in which tissue(s)?
prostate
221
Alkaline phosphatase (ALP) is found in which tissue(s)?
almost all tissues
222
Aspartate aminotransferase (AST) is found in which tissue(s)?
highest in liver, heart, skeletal muscle
223
Alanine aminotransferase (ALT) is found in which tissue(s)?
Liver, RBCs
224
Gamma glutamyl transferase (GGT) is found in which tissue(s)?
liver, kidneys, pancreas
225
Lactate dehydrogenase (LDH) is found in which tissue(s)?
All tissues
226
Creatine kinase (CK) is found in which tissue(s)?
skeletal muscle, cardiac muscle, brain
227
Amylase (AMS) is found in which tissue(s)?
salivary glands, pancreas
228
Lipase (LPS) is found in which tissue(s)?
pancreas
229
Glucose-6-phosphate dehydrogenase (G6PD) is found in which tissue(s)?
RBCs
230
An increase in ACP in clinically significant for...
prostate cancer
231
Which enzyme is not used to diagnose prostate cancer due to being more specific than ACP?
PSA
232
Increased ALP is clinically significant for...
liver and bone disease
233
Higher levels of ALP are seen in hepatocellular disorders or biliary tract obstruction?
biliary tract obstruction
234
Which enzyme will be increased in children, pregnant women, adolescents, and patients with healing bone fractures?
Alkaline phosphatase (ALP)
235
Increased AST can be clinically significant for...
liver disease, viral hepatitis, acute MI, muscular dytrophy
236
Which enzyme will be markedly increased in viral hepatitis?
AST (and ALT)
237
Which is more specific to the liver: AST or ALT?
ALT
238
An increase in ALT is clinically significant for...
liver disease
239
What is the most sensitive enzyme for all types of liver disease?
GGT
240
Which enzyme can be used to monitor abstention from alcohol?
GGT
241
Increased GGT is clinically significant for...
all heptobiliary disorders, chronic alcoholism
242
Highest levels of GGT are seen with
obstructive disorders
243
Which enzyme catalyzes the reaction: lactic acid to pyruvate?
LDH
244
Highest levels of LDH are seen in...
pernicious anemia
245
Increases in LDH are clinically significant for...
pernicious anemia, AMI, liver disease
246
Which enzyme catalyzes the reaction: phosphocreatine + ADP to creatine + ATP?
CK
247
CK is inhibited by all anticoagulants except...
heparin
248
What is the most sensitive enzyme for skeletal muscle disease?
CK
249
Highest levels of CK are seen in...
muscular dystrophy
250
Increased CK can be clinically significant for...
AMI, muscular dystrophy
251
Which enzyme creaks down starch to simple sugars?
amylase
252
In acute pancreatitis, what is the rise, peak and fall of amylase?
rise: 2-12 hours
peak: 24 hours
fall: 3-5 days
253
Increased amylase is clinically significant for...
acute pancreatitis, other abdominal diseases, mumps
254
Increased lipase is clinically significant for...
acute pancreatitis
255
Which enzyme breaks down triglycerides into fatty acids and glycerol?
lipase
256
Which is more specific for pancreatic disease: lipase or amylase?
lipase
257
An inherited deficiency of this enzyme can lead to drug induced hemolytic anemia.
G6PD
258
CK-MB will be increased in which type of disorder?
cardiac disorder
259
AST, ALT, LDH will be increased in which type of disorder?
hepatocellular disorders
260
ALP and GGT will be increased in which type of disorder?
biliary tract obstruction
261
CK, AST, LDH, and aldolase will be increased in which type of disorder?
skeletal muscle disorders
262
ALP will be increased in which type of disorder?
bone disorders
263
amylase and lipase will be increased in which type of disorder?
acute pancreatitis
264
Name 3 cardiac markers for AMI.
CK-MB, myoglobin, troponin
265
Which cardiac marker is the first to rise after an AMI?
myoglobin
266
Which cardiac marker has the highest sensitivity and specificity for an AMI?
Troponin
267
What is considered a definitive marker for AMI?
Troponin
268
What substance is released from heart muscle of the left ventricle in CHF?
B-type natriuretic peptide (BNP)
269
What test tests for heart failure?
BNP
270
What is the clinical significance of using BNP as a test for heart failure?
B-type natriuretic peptide (BNP) is released from the heart muscle of the left ventricle when fluid builds from heart failure. The BNP then acts on the kidneys to increase excretion of fluid.
271
What is the best single marker for predicting cardiovascular events?
hs-CRP
272
What test can be used to identify individuals at risk of cardiovascular disease?
hs-CRP
273
Name 5 tests that can be used to test for Coronary Artery disease (CAD)
Cardiac C-reactive protein, total cholesterol, HDL, LDL, Trigs
274
What is the major cause of CAD and is a primary target for therapy?
LDL
275
Which enzyme is needed to conjugate bilirubin?
glucuronyl transferase
276
What is formed in the intestines from bacterial action on bilirubin?
urobilinogen
277
Increases in total bilirubin can be clinically significant for..
liver disease, hemolysis, HDFN, kernicterus (brain damage) in infants
278
What is a special requirement in the collection of bilirubin samples?
the sample must be protected from light
279
Jendrassik-Grof method is used to measure...
bilirubin
280
What is added to the Jendrassik-Grof method so unconjugated bilirubin reacts?
accelerator
281
What reagent is used in the Jendrassik-Grof method to measure bilirubin?
Diazo reagent
282
Another term for conjugated bilirubin is...
direct bilirubin
283
Increases in conjugated bilirubin can be clinically significant for...
liver disease, obstructive jaundice
284
Delta bilirubin is bilirubin that is bound to...
albumin
285
When is delta bilirubin only typically seen?
significant hepatic obstruction
286
Which form of bilirubin isn't measured, but calculated?
unconjugated bilirubin
287
Increases in unconjugated bilirubin can be clinically significant for...
prehepatic, posthepatic, and some types of hepatic jaundice
288
Which types of bilirubin are bound to albumin?
unconjugated and delta bilirubin
289
Which bilirubin is soluble in water?
conjugated bilirubin
290
Which bilirubin is not present in urine?
unconjugated bilirubin
291
What type of reaction does unconjugated bilirubin have with diazotized sulfanilic acid?
indirect (reacts only in the presence of an accelerator)
292
What type of reaction does conjugated bilirubin have with diazotized sulfanilic acid?
direct (reacts without accelerator)
293
Which form of bilirubin has high affinity for brain tissue?
unconjugated bilirubin
294
Which form of bilirubin is nonpolar?
unconjugated bilirubin
295
Which form of bilirubin is polar?
conjugated bilirubin
296
```
What would the results of the following tests typically look like for prehepatic jaundice?
Total bilirubin:
Direct Bilirubin:
Urine bilirubin:
Urine urobilinogen:
```
Total bilirubin: increased
Direct Bilirubin: normal
Urine bilirubin: neg
Urine urobilinogen: increased
297
```
What would the results of the following tests typically look like for hepatic jaundice?
Total bilirubin:
Direct Bilirubin:
Urine bilirubin:
Urine urobilinogen:
```
Total bilirubin: increased
Direct Bilirubin: variable
Urine bilirubin: variable
Urine urobilinogen: decreased
298
```
What would the results of the following tests typically look like for posthepatic jaundice?
Total bilirubin:
Direct Bilirubin:
Urine bilirubin:
Urine urobilinogen:
```
Total bilirubin: increased
Direct Bilirubin: increased
Urine bilirubin: positive
Urine urobilinogen: decreased
299
Name 6 Anterior pituitary hormones.
ACTH, FSH, GH, LH, Prolactin, TSH
300
Which hormone regulates the production of adrenocortical hormones by the adrenal cortex?
ACTH
301
ACTH is regulated by which hormone secreted from the hypothalamus?
corticotropin-releasing hormone (CRH)
302
Which pituitary hormone is increased in Cushing's disease?
ACTH
303
TRUE OR FALSE: ACTH expresses diurnal variation.
True - highest levels are in the morning
304
Which pituitary hormone needs to be collected on ice and stored frozen?
ACTH
305
Which pituitary hormone regulates sperm and egg production?
FSH
306
FSH is regulated by which hormone secreted from the hypothalamus?
gonado-tropin releasing hormone (GnRH)
307
Which pituitary hormones sharply increase just before ovulation?
FSH and LH
308
Which pituitary hormone regulates protein synthesis, cell growth and division?
growth hormone (GH)
309
Which hormones secreted from the hypothalamus regulate GH?
growth-hormone releasing hormone (GHRH) and somatostatin
310
Increased levels of GH can be clinically significant for...
gigantism and acromegaly
311
Decreased levels of GH can be clinically significant for...
dwarfism
312
Which pituitary hormone regulates follicle maturation, ovulation, production of estrogen, progesterone, testosterone?
LH
313
Which hormone secreted by the hypothalamus regulates the secretion of LH?
GnRH
314
Which pituitary hormone regulates lactation?
Prolactin
315
Which hypothalamus hormones regulate prolactin?
prolactin-releasing factor (PRF) and prolactin-inhibiting factor (PIF)
316
Which pituitary hormone regulates the production of T3 and T4 by the thyroid?
TSH
317
Which hypothalamus hormone regulates the secretion of TSH?
thyrotropin-releasing hormone (TRH)
318
Increased levels of TSH are seen in...
hypothyroidism
319
Decreased levels of TSH are seen in...
hyperthyroidism
320
Name 2 posterior pituitary hormones.
ADH and oxytocin
321
Which pituitary hormone regulates the reabsorption of water in the distal renal tubules?
ADH
322
Which pituitary hormones are actually produced in the hypothalamus, but then stored in the posterior pituitary?
ADH and oxytocin
323
The release of ADH is stimulated by...
increased osmolality, decreased blood volume or blood pressure
324
ADH is (increased or decreased) in diabetes insipidus.
decreased
325
Which pituitary hormone regulates uterine contractions during childbirth and lactation?
oxytocin
326
What is another name for thyroxine?
T4
327
What is another name for triidothyronine?
T3
328
T4 is short for which thyroid hormone?
thyroxine
329
T3 is short for which thyroid hormone?
triidothyronine
330
Which thyroid hormone(s) regulate metabolism, growth, and development?
T3 and T4
331
Calcitonin is a thyroid hormone that regulates...
inhibits calcium reabsorption
332
Name 3 thyroid hormones.
thyroxine (T4), triidothyronine (T3), and calcitonin.
333
T3 and T4 are regulated by which hormone?
TSH
334
Most T4 is bound to...
thyroxine-binding globulin (TBG)
335
What is the principle thyroid hormone that is the most concentrated?
T4
336
T3 and T4 are increased in...
hyperthyroidism
337
T3 and T4 are decreased in...
hypothyroidism
338
Most T3 is formed from...
deiodinized T4
339
How many atoms of iodine does T3 contain?
3
340
How many atoms of iodine does T4 contain?
4
341
Which thyroid hormone is the most potent?
T3
342
Which thyroid hormone has the highest concentration?
T4
343
Which thyroid hormone is important in diagnosing thyroid cancer?
calcitonin
344
Parathyroid hormone (PTH) regulates...
Calcium and phosphate
345
What would be the expected test results for the following in hyperparathyroidism?
PTH
Calcium
Phosphate
PTH: increased
Calcium: increased
Phosphate: decreased
346
What would be the expected test results for the following in hypoparathyroidism?
PTH
Calcium
Phosphate
PTH: decreased
Calcium: decreased
Phosphate: increased
347
A thyroid insufficiency is called...
primary hypothyroidism
348
A pituitary insufficiency in regards to hypothyroidism is termed...
secondary hypothyroidism
349
What is the most common cause of hyperthyroidism?
Graves Disease
350
What types of tests are used for thyroid testing?
immunoassays
351
In primary hypothyroidism, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH: increased
FT4: decreased
FT3: decreased
352
In secondary hypothyroidism, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH: decreased
FT4: decreased
FT3: decreased
353
In hyperthyroidism, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH:decreased
FT4: increased
FT3: increased
354
In T3 thyrotoxicosis, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH: decreased
FT4: normal
FT3: increased
355
TRUE OR FALSE: If the TSH test comes back normal, T3 and T4 should be tested next.
False. no further testing is needed
356
What is the biologically active form of T3 and T4?
Free T3 and Free T4
357
What is the first test used to screen for thyroid problems?
TSH
358
Due to free T3 not being helpful in diagnosing hypothyroidism, it is usually only tested when...
TSH is decreased and FT4 is not increased (possible thyrotoxicosis)
359
What is the next test ordered when TSH is abnormal?
FT4
360
Name the adrenal cortex hormones.
aldosterone and cortisol
361
Aldosterone regulates...
reabsorption of sodium in the renal tubules
362
Increases in aldosterone can cause...
hypertension (due to water and sodium retention)
363
Decreases in aldosterone can lead to...
severe water and electrolyte abnormalities
364
Cortisol regulates...
carbohydrate, fat, and protein metabolism, water and electrolyte balance, suppresses inflammatory and allergic reactions
365
Cortisol is regulated by...
ACTH
366
Which adrenal cortex hormone expresses diurnal variation?
cortisol
367
Cushing's syndrome is...
when there is an increase in cortisol with loss of diurnal variation
368
Decreased levels of cortisol are seen in...
Addison's disease
369
Which hormones are responsible for the "fight or flight syndrome"?
epinephrine and norepinephrine
370
What is the primary hormone of the adrenal medulla?
epinephrine
371
Epinephrine and norepinephrine regulate...
stimulation of the sympathetic nervous system
372
Epinephrine and norepinephrine are categorized as
catecholamines
373
What are the metabolites of epinephrine and norepinephrine?
metanephrines and VMA
374
What is the term used to describe a rare chatecolamine producing tumor?
pheochromocytoma
375
Increased levels of chatecholamines are seen with...
pheochromocytoma
376
Which hormones are responsible for the development of female reproductive organs and secondary sex charateristics that also regulate the menstrual cycle and maintain pregrgnancy?
estrogens
377
What is the major estrogen produced by the ovaries?
Estradiol
378
What is the most potent estrogen?
Estradiol
379
Other than the ovaries, where else can estrogen be produced?
adrenal cortex
380
Which hormone prepares the uterus for ovum implantation and helps maintain pregnancy?
progesterone
381
What reproductive hormone can be used to monitor fetal growth and development?
Estriol (estrogen)
382
Which hormone is useful in infertility studies and assess placental functions?
progesterone
383
Pregnanediol is a metabolite of...
progesterone
384
Which hormone is considered progesterone production by corpus luteum during early pregnancy and regulated the development of fetal gonads?
HCG
385
Which hormone is used to detect pregnancy?
HCG
386
Other that detecting pregnancy, HCG can be useful in detecting...
gestational trophoblastic disease, testicular tumor, and other HCG-producing tumors
387
Human placental lactogen (HPL) regulates..
estrogen and progesterone production by the corpus luteum.
development of mammary glands
388
Which hormone regulates development of male reproductive organs and secondary sex characteristics?
testosterone
389
Insulin regulates...
carbohydrate metabolism
390
Glucagon regulates...
glycogenolysis, gluconeogenesis, lipolysis
391
Insulin is produced in which cells of the islets of Langerhans?
bet cells
392
Glucagon is produced by which cells of the islets of Langerhans?
alpha cells
393
What hormone causes increased movement of glucose into cells for metabolism?
insulin
394
Which hormone increases plasma glucose levels?
glucagon
395
Which hormone decreases plasma glucose levels?
insulin
396
Insulin is decreased in which disease?
diabetes mellitus
397
Insulin is increased in which events?
insulinoma, hypoglycemia
398
What term is used to describe the lowest concentration of a drug in blood that will produce desired effect?
minimum effective concentration (MEC)
399
What term is used to describe the lowest concentration of drug in blood that will produce adverse response?
minimum toxic concentration (MTC)
400
What is therapeutic index?
ratio of MTC to MEC
401
What term is used to describe the lowest concentration of drug measured in blood that should be reached just before the next scheduled dose and should fall below the MEC?
Trough
402
What is the term to describe the highest concentration of drug measured in blood that is drawn immediately on achievement of steady state and should not exceed MTC?
Peak
403
What term is used to describe the amount of drug absorbed and distributed equals the amount of drug metabolized and excreted?
steady state.
404
How many half lives does it usually take to reach a steady state?
5-7 half-lives
405
What is a half-life?
Time required for concentration of a drug to be decreased by half
406
salicylates and acetaminophen are of which therapeutic drug group?
analgesics
407
Which therapeutic drug group does the following drug belong to? Phenobarbital
antiepileptics
408
Which therapeutic drug group does the following drug belong to? phenytoin
antiepileptics
409
Which therapeutic drug group does the following drug belong to? valproic acid
antiepileptics
410
Which therapeutic drug group does the following drug belong to? carbamazepine
antiepileptic
411
Which therapeutic drug group does the following drug belong to? ethosuximide
antiepileptic
412
Which therapeutic drug group does the following drug belong to? felbamate
antiepileptic
413
Which therapeutic drug group does the following drug belong to? gabapentin
antiepileptic
414
Which therapeutic drug group does the following drug belong to? lamotrigine
antiepileptic
415
Which therapeutic drug group does the following drug belong to? methotrexate
antineoplastics
416
Which therapeutic drug group does the following drug belong to? aminoglycosides (amikacin, gentamicin, kanamycin, tobramycin)
antibiotics
417
Which therapeutic drug group does the following drug belong to? vancomycin
antibiotics
418
Which therapeutic drug group does the following drug belong to? digoxin
cardioactives
419
Which therapeutic drug group does the following drug belong to? disopyramide
cardioactives
420
Which therapeutic drug group does the following drug belong to? procainamide
cardioactives
421
Which therapeutic drug group does the following drug belong to? quinidine
cardioactives
422
Which therapeutic drug group does the following drug belong to? tricylic antidepressants
psychoactives
423
Which therapeutic drug group does the following drug belong to? lithium
psychoactives
424
Which therapeutic drug group does the following drug belong to? cyclosporine
immunosuppressant
425
Which therapeutic drug group does the following drug belong to? tacrolimus
immunosuppressant
426
gas chromatography and enzymatic methods are used to detect which toxic substance?
ethanol
427
Differential spectrophotometry (co-oximeter) and gas chromatography are used to detect which toxic substance?
carbon monoxide
428
Atomic absorptions is used to detect which toxic substances?
arsenic and lead
429
Which toxic substance is detected by measuring serum pseudocholinesterase?
pesticides
430
(AFP) a-fetoprotein is a tumor marker for which type of cancer?
liver
431
Cancer antigen (CA) 15-3 is a tumor marker for which type of cancer?
breast
432
Cancer antigen (CA) 19-9 is a tumor marker for which type of cancer?
pancreatic
433
Cancer antigen (CA) 125 is a tumor marker for which type of cancer?
ovarian
434
Carcinoembryonic antigen (CEA) is a tumor marker for which type of cancer?
colorectal
435
Human chorionic gonadotropin (hCG) is a tumor marker for which type of cancer?
ovarian and testicular
436
Prostate-specific antigen (PSA) is a tumor marker for which type of cancer?
prostate
437
thyroglobulin is a tumor marker for which type of cancer?
thyroid
438
Name 4 clinical uses of tumor markers.
Aid in diagnosis, stage disease, monitor therapy, and detect recurrence
439
TRUE OR FALSE: Tumor markers alone can be used to diagnose cancer.
FALSE. Most are not useful in screening
440
Which tumor marker is produced by the fetal liver, re-expressed in certain tumors, and also increased in hepatitis and pregnancy?
a-fetoprotein (AFP)
441
Which tumor marker can be increased in smokers?
carcinoembryonic antigen (CEA)
442
What can be defined as a weak acid and it's salt or conjugate base that minimizes changes in pH?
buffer
443
What is the most important buffer in the human body?
bicarbonate/carbonic acid (buffers blood pH)
444
What is the formula for the blood pH buffer?
H+ + HCO3- H2CO3 H2O + CO2
445
total CO2 - 1 = ?
bicarbonate
446
Bicarbonate is regulated by the...
kidneys
447
What is the Henderson-Hasselbalch equation?
pH = 6.1 + log(HCO3/H2CO3)
448
When blood pH decreases, this is an...
acidosis
449
When blood pH increases, this is an...
alkalosis
450
What compensates for a respiratory acid-base problem?
kidneys
451
What compensates for a metabolic acid-base problem?
lungs
452
What condition has:
decreased pH
increased PCO2
normal HCO3-
respiratory acidosis
453
What is the ideal ratio for PCO2:HCO3-?
20:1
454
What condition has:
decreased pH
normal PCO2
decreased HCO3-
metabolic acidosis
455
What condition has
increased pH
decreased PCO2
normal HCO3-
respiratory alkalosis
456
What condition has:
increased pH
normal PCO2
increased HCO3-
metabolic alkalosis
457
How is respiratory acidosis compensated?
Kidneys retain HCO3- and excrete H+
458
How is metabolic acidosis compensated?
hyperventilation (excrete CO2)
459
How is respiratory alkalosis compensated?
kidneys excrete HCO3- and retain H+
460
How is metabolic alkalosis compensated?
hypoventilation (retain CO2)
461
What is the term to describe low O2 content in arterial blood?
hypoxemia
462
What is the term to describe lack of O2 at the cellular level?
hypoxia
463
What is the term to describe baromertric pressure times % gas concentration?
partial pressure
464
What is the term to describe the amount of dissolved CO2 in blood?
PCO2
465
What is a measurement of respiratory component that is inversely proportional to respiration?
PCO2
466
What assesses pulmonary function?
PO2
467
What is the term to describe a graph showing the relationship between oxygen saturation and PO2?
oxygen dissociation curve
468
The oxygen dissociation curve provides information about...
hemoglobin's affinity for O2
469
What is the phosphate compound in RBCs that at low levels, inhibits the release of O2 to tissues?
2,3-Diphosphoglycerate (2,3-DPG)
470
What is the term to describe the amount of O2 that is combined with hemoglobin and is expressed as % O2 that can be combined with hemoglobin?
oxygen saturation
471
1 g of Hgb can combine with how many mL of O2?
1.34 mL
472
What is the term to describe the partial pressure of O2 at which hemoglobin oxygen saturation is 50%.
P50
473
What does it mean if the value for P50 is low?
there is increased oxygen affinity (shift to the left in the O2 dissociation curve)
474
What does it mean if the value for P50 is high?
there is decreased oxygen affinity (shift to the right in the O2 dissociation curve)
475
What is the reference range for blood pH?
7.35-7.45
476
What is the reference range for PCO2?
35-45 mm Hg
477
What is the reference range for PO2?
80-100 mm/Hg
478
What is the reference range for arterial blood HCO3-?
22-26 mmol/L
479
What is the reference range for total CO2 in arterial blood?
23-27 mmol/L
480
A pH electrode measures..
[H+]
481
The Severinghaus electrode measures...
Dissolved CO2
482
The Clark electrode measures...
Dissolved O2
483
The co-oximeter measures...
oxygen saturation
484
If an arterial blood gas sample was at room temperature for more than 30 minutes, what would the effects be?
decreased PO2
decreased pH
Increased PCO2
485
If an arterial blood gas sample was exposed to air, what would the effects be?
decreased PCO2, increased pH, increased PO2
486
Albumin/(total protein-albumin) = ?
A/G ratio (1-2.5)
487
(Na+ + K+) - (Cl- + HCO3-) = ?
Anion gap (10-20
488
An increased BUN:Crea ration with increased BUN and normal Crea indicates...
prerenal condition
489
An increased BUN:Crea ratio with increased Crea indicates...
postrerenal condition
490
A reversed A/G ratio can be clinically significant for...
multiple myeloma and liver disease
491
Reasons for an increased anion gap.
```
Salicylate poisoning
Lactic acidosis
Unmeasured anions
Methanol
Polyethylene glycol
Ethanol
Diabetic ketoacidosis
```
492
(Urine Crea x Urine Volume mL) / (plasma crea x time in minutes) =?
creatinine clearance
493
A decreased creatinine clearance is an early indicator for...
renal disease
494
2(Na+) + (glu/20) + (BUN/3) = ?
calculated osmolality (275-295 Osm/kg)
495
Measured osmolality - calculated osmolality = ?
osmolal gap (0-10 mOsm/kg)
496
What are reasons for an osmolal gap to be >10?
```
Methanol
Ethanol
Diuretics
Isopropyl alcohol
Ethylene glycol
```
497
Decreased urine:serum osmolality can be clinically significant for...
renal tubular deficiency, diabetes insipidus
